title: Impact of diabetes and prediabetes on the short-term prognosis in patients with acute ischemic stroke.
abstract: OBJECTIVE
  We aimed to explore the association between abnormal glucose metabolism such as diabetes, prediabetes, and short-term prognosis in patients with acute ischemic stroke.
  
  
  METHODS
  Of 242 consecutive acute ischemic stroke patients, a 75-g oral glucose tolerance test was administered to 116 patients without previously diagnosed diabetes. One hundred forty patients were classified into diabetes, 52 patients were prediabetes (impaired glucose tolerance or impaired fasting glucose or both), and 50 patients were normal glucose tolerance (NGT). The association between each glycemic status and early neurological deterioration (END; increase in the NIH Stroke Scale (NIHSS) of ≥2 points during the first 14days after admission) or poor short-term outcome (30-day modified Ranking Scale [mRS] score 2-6) was evaluated.
  
  
  RESULTS
  In multivariable analysis, the risk of END was significantly higher in the diabetes group than in the NGT group (ORs=11.354; 95% CI, 1.492-86.415; p=0.019), even after adjustment for possible confounding factors (ORs=12.769; 95% CI, 1.361-119.763; p=0.026). Similar but insignificant associations were observed between prediabetes and NGT groups (ORs=6.369; 95% CI, 0.735-55.177; p=0.093). The risk of poor outcome (30-day mRS 2-6) was significantly higher in the diabetes group (ORs=3.667; 95% CI, 1.834-7.334; p<0.001) than in the NGT group, even after adjusting for confounding factors (ORs=3.340; 95% CI, 1.361-8.195; p=0.008). Similar but insignificant associations were observed between prediabetes and NGT groups (ORs=2.058; 95% CI, 0.916-4.623; p=0.08).
  
  
  CONCLUSIONS
  In our patient population, both diabetes and prediabetes were associated with a poor early prognosis after acute ischemic stroke.
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan. r_tanaka@juntendo.ac.jp
authors.forename: Ryota
authors.initials: R
authors.lastname: Tanaka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Miyamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamashiro
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimura
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D016017:Odds Ratio; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D013997:Time Factors
keywords: AGM; ATI; Acute stroke; BAD; BMI; CE; CT; DL; DM; Diabetes; END; Early neurological deterioration; HDL; HT; IFG; IGT; LDL; LI; MRI; NGT; NIHSS; National Institutes of Health Stroke Scale; OGTT; Oral glucose tolerance test; Prediabetes; RS; TIA; UE; Worse prognosis; abnormal glucose metabolism; atherothrombotic infarction; cardioembolic infarction; computed tomography; diabetes mellitus; dyslipidemia; early neurological deterioration; high density lipoprotein; high-body mass index; hypertension; impaired fasting glucose; impaired glucose tolerance; in-hospital recurrence of stroke; intracranial branch atheromatous disease; lacunar infarction; low density lipoprotein; mRS; magnetic resonance imaging; modified Ranking Scale; normal glucose tolerance; oral glucose tolerance test; preDM; prediabetes; transient ischemic attack; undetermined etiology